CMS Announces Proposed Rule for ACOs

CMS announced a major change coming for Accountable Care Organizations (ACOs) in a 607-page proposed rule and a Health Affairs article from CMS Administrator Seema Verma today. The rule will cut the time ACOs can remain in the program without assuming risk from six years to two years. Under current regulations, only one in five ACOs are currently at risk of losing money in the Medicare Shared Savings Program, as the majority of ACOs have chosen "Track 1," in which ACOs can share in savings if they hit key goals but are not at risk. This is especially true in rural America where razor thin margins means that the cost of implementing the changes to be a part of an ACO is a significant source of risk already.
 
Under the proposed new rule, the three-track program would cut to two options: “a "BASIC" path that steadily ramps up risk, and an "ENHANCED" path that would allow providers to immediately qualify as an Advanced Alternative Payment Model under Medicare's physician payment law.” In the rule, CMS predicts that 109 current ACOs, or approximately one in five, will drop out of the program in the next ten years. Likely more of the ACO participants that will be forced to drop out will be small and rural providers.
 
NRHA is examining this rule in greater detail and will continue to monitor proposed changes for ACOs from CMS, seek your input, and will post comments on the regulatory section of ruralhealthweb.org once submitted. You can view the rule here.
 

Comments

Angie Enriquez

UPDATE
https://www.ruralhealthweb.org/blogs/ruralhealthvoices/august-2018/cms-announces-proposed-rule-for-acos?saved=1

I really appreciate your blog and bringing to light what is going on in the politics that will soon become the basis on how primary care doctors are paid. I read the the PDF link that you provided (Medicare,2018). I appreciate you providing the link. I associated it with the basis of the blog and rural medicine. I can see that it may become a very big problem where our small clinics here in the rural areas are struggling now to stay open. We are having doctors come from 500 miles away to do shifts in our hospitals and clinics, because the areas are so poor that we have very little to offer doctors and other medical professionals to come make these areas their homes. With this new way to pay providers by offering them bonuses/kickbacks to reduce the overall cost of individual's health procedures; I fear that we will see a rise in morbidity and mortality rates. I fear this because the primary care providers are not ordering needed testing. I fear they will do this to get the money as part of the Shared Savings Program. This would save many of our rural healthcare facilities, but it would be at the cost of the health of the beneficiaries. The way it is stated it already provides data of failure. As you stated most of it is predicted that one in five will drop out within the first ten years. The part that was most concerning is that these will be mostly in the rural areas (Medicare, 2018). Obviously this was a well thought out proposal, because it contained over 600 pages. I don't agree that because it was well thought out that it was properly thought out for the benefit of the participants.
To summarize my thoughts on your blog is that it is appreciated. I thank you for taking into consideration the rural areas. The rural areas sometimes go without a voice because they have small populations and they often go without political representation. I do not feel that any provider should be rewarded by reducing the amount of tests or procedures that is recommended for a patient. I am working on a paper that is based on rural healthcare and how it relates to certain areas of politics. I find your blog to be most helpful, as it contains many PDFs and links to laws that are relevant to rural healthcare.
The PDF document is scheduled to be published in the
Federal Register on 08/17/2018 and available online at
https://federalregister.gov/d/2018-17101, and on govinfo.gov

  • 8/11/2018 3:11:45 PM

Angie Enriquez

I really appreciate your blog and bringing to light what is going on in the politics that will soon become the basis on how primary care doctors are paid. I read the the PDF link that you provided (Medicare,2018). I appreciate you providing the link. I associated it with the basis of the blog and rural medicine. I can see that it may become a very big problem where our small clinics here in the rural areas are struggling now to stay open. We are having doctors come from 500 miles away to do shifts in our hospitals and clinics, because the areas are so poor that we have very little to offer doctors and other medical professionals. With this new way to pay providers, by offering them bonuses/kickbacks to reduce the overall cost of individual's health procedures. I fear that we will see a rise in morbidity and mortality rates, because the primary care providers are not ordering needed testing. I fear they will do this to get the money as part of the Shared Savings Program. This would save many of our rural healthcare facilities, but it would be at the cost of the health of the beneficiaries. The way it is stated it already provides data of failure. As you stated most it is predicted that one in five will drop out within the first ten years. The part that was most concerning is that these will be mostly in the rural areas (Medicare, 2018). Obviously this was a well thought out proposal, because it contained over 600 pages. I don't agree that because it was well thought out that it was properly thought out.
To summarize my thoughts on your blog it is appreciated. I thank you for taking into consideration the rural areas. They are sometimes go without a voice because they have small populations and they often go without political representation. I do not feel that any provider should be rewarded by reducing the amount of tests or procedures that is recommended for a patient.
The PDF document is scheduled to be published in the
Federal Register on 08/17/2018 and available online at
https://federalregister.gov/d/2018-17101, and on govinfo.gov

  • 8/11/2018 2:44:36 PM


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